Reports from Sweden, Hawaii and France have each demonstrated that abdominal obesity, i.e., central, upper-body, or """"""""apple"""""""", can be predictive of ischemic heart disease (IHD). These prospective cohort studies employed different simple indicates of body-fat distribution such as waist-to-hip circumference ratio or subscapular skinfold. Their similar results, however, suggest that increased abdominal obesity confers approximately a two-fold increased risk of IHD among middle-aged men. The effect among females may be stronger. This proposal approaches the epidemiologic relationship between IHD incidence and simple indices of fat distribution using the case-control method instead of a more costly prospective cohort. Two parallel, case- control protocols are proposed. A hospital based investigation will study 450 early survivors of a first IHD event (cases), 450 matched neighborhood controls and 450 hospital controls (suspected of IHD, but with negative work-up). A morgue-based study will involve 354 non-survivors of a first IHD event, 354 matched neighborhood controls and 354 controls who died from an acute process and were free of IHD. These two studies will permit the testing of alternative fat-distribution indices which may be stronger risk factors for IHD incidence than the waist-to-hip ratio of the subscapular skinfold. The proposed anthropometric data sets will include 6 girths, 7 skinfolds, abdominal sagittal diameter, height and weight. Principal component and canonical correlations analyses will assist the researchers to identify combinations of these measures which efficiently distinguish cases from controls. The analyses for both protocols will consider males and females separately. Possible confounders of the association between fat-distribution indices and IHD (e.g., race, age, tobacco use, alcohol use, diabetes) will be considered and, if required, adjusted for in multivariate analysis. These protocols will provide a previously unavailable combination, in one America data set, of well documented IHD outcomes and a variety of fat- distribution measurements. Any improved indices identified in these studies will have potential utility for future prospective investigations, for intergroup comparisons of IHD risk, for patient assessment and perhaps for the rapid evaluation of protective interventions (e.g., diet, exercise programs) against cardiovascular disease.
| Kahn, H S; Simoes, E J; Koponen, M et al. (1996) The abdominal diameter index and sudden coronary death in men. Am J Cardiol 78:961-4 |
| Kahn, H S (1996) The accumulation of visceral adipose tissue may be influenced by intra-abdominal temperature. Obes Res 4:297-9 |
| Kahn, H S; Austin, H; Williamson, D F et al. (1996) Simple anthropometric indices associated with ischemic heart disease. J Clin Epidemiol 49:1017-24 |
| Kahn, H S; Williamson, D F (1994) Abdominal obesity and mortality risk among men in nineteenth-century North America. Int J Obes Relat Metab Disord 18:686-91 |
| Emery, E M; Schmid, T L; Kahn, H S et al. (1993) A review of the association between abdominal fat distribution, health outcome measures, and modifiable risk factors. Am J Health Promot 7:342-53 |
| Kahn, H S (1993) Choosing an index for abdominal obesity: an opportunity for epidemiologic clarification. J Clin Epidemiol 46:491-4 |
